Ectopic beat detector



April 15, 1969 H. KARSH 3,438,368

ECTOPIC BEAT DETECTOR Filed Sept. 27, 1966 Sheet of 2 22 24 /26D 28 30 A PULSE ONE AVE ME MR 5 GEN. C SHOT CKT 86 84 M A METER 92 DIFFER F PULSE G RELAY H =2 ENTL TOR s/EN DRIVER 90 l 34 3 COUNTER 94 HIGH DELAY CAR p E STORE AMP INVENTOR. HERBERT KARSH ATTORNEY April 15, 1969 KARSH 3,438,368

ECTOPI C BEAT DETECTOR Filed Sept. 27, 1966 Sheet o1-2 32 A B b b H H H H H \r c H H H H H H H H.

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INVENTOR. HERBERT KARSH BY ATTORNEY United States Patent 3,438,368 ECTOPIC BEAT DETECTOR Herbert Karsh, Lexington, Mass., assignor to Lexington Instrument Corporation, Waltham, Mass., a corporation of Massachusetts Filed Sept. 27, 1966, Ser. No. 582,422 Int. Cl. A61b 5/04 US. Cl. 1282.06 5 Claims This invention relates to electro-cardiology and more particularly to novel apparatus for electrically detecting the occurrence of ectopic heart beats.

Ectopic heart beats are frequently symptomatic of serious cardiac difficulties. They are often ditficult to detect, particularly in cases where the ectopic beat occurs infrequently. However, by continuous aural monitoring over a period of time during which such beats can be expected to occur, they can be detected but require uninterrupted attention and observation of an attending physician or techniclan.

The present invention is intended to free individuals from the function of continuous monitoring and provide indication of ectopic beats.

Devices providing automatic, continuous, electrical indication of potentials corresponding to heart functions are common, such as the well known electrocardiographs and a number of cardiotachometers. Prolonged electrocardiography with moving tapes is rarely feasible unless a detailed examination of the electrocardiographic wave form is desired. For the limited purpose of monitoring the heart rate, cardiotachometers are generally used and are generally of two types, either the so-called beat-by-beat detector, or the averaging cardiotachometer.

The beat-by-beat detector is generally based upon a system whereby a charge storage device provides voltage levels corresponding respectively to the interval between the two immediately preceding heart beats detected. The level of charge or potential is then sampled at fixed intervals after each beat, and that level displayed.

If the heart beat rate is constant, of course, the sampling will continue to exhibit substantially the same potential and the detector will stay at a fixed level. A change in the heart rate will result in a step change in the indicator level inasmuch as the beat-by-beat detector ignores any measurement more remote than the interval between the two last heart beats. As the usual heart beat rate is rarely precisely constant, the output of this type of detector is usually a series of up and down level changes and it is difficult to distinguish an ectopic beat in the record.

An averaging detector is based upon the principle that the energy output for each heart beat is substantially constant and therefore the device generates a series of pulses corresponding in time to the heart beats, each pulse having a fixed energy constant. The energy of the pulses is averaged in time as by passing them through a leaky RC circuit, thereby providing an output signal in which the average rate is weighted to give the most significance to the most recent measurement of rate, and the least significance to the most remote rate measured, the difference in the significance varying exponentially. Thus, changes in the heart beat rate will be reflected by ramps in the detector output. The response of an averaging detector to an abrupt change in a pulse rate, as from an ectopic beat, is seriously damped by the necessary high time constant of the averaging circuit.

Averaging detectors are typically employed to provide the average heart rate, the latter being indicative of the heart burden required to maintain adequate perfusion. Also the average heart rate taken together with the stroke volume, as detected by a flow meter, provides cardiac output measurement.

Because the beat-by-beat detector yields an instantaneous heart rate, it was originally developed for detection of cardiac reactions to emotional stimuli. It has since served additional purposes inasmuch as it clearly displays heart jitter or short term rate irregularities which are clinically significant and is also used to detect fetal heart distress during birth.

It will be apparent that the amplitude of the signal in either the average or the beat-by-beat detector is dependent upon the heart beat rate. Hence, if either measures a heart beat rate of, for example, 60 pulses per minute (ppm) and provides an output signal level of X, then for a ppm. rate the signal level will preferably rise to about 2X. It will be apparent that an ectopic beat, interposed between two regular beats, in an otherwise steady pulse train, will cause an output transition in a beat-bybeat detector and be practically ignored in an averaging detector.

A principal object of the present invention is to provide electronic instrumentation particularly adapted for continuous monitoring of heart beat rates so as to detect and count ectopic beats.

Yet another object of the present invention is to provide a cardiotachometer which, as long as any changes in the pulse rate remains substantially constant in time, continues to provide a constant signal, yet when an abrupt change in pulse rate occurs, as from ectopic beats, gives a positive indication of that change.

Another object of the present invention is to provide apparatus adapted to provide a number of different clinically significant outputs based upon an input consisting of a train of heart beat derived pulses: the average rate, the instantaneous rate, ectopic beat detection, and count.

Other objects of the invention will in part be obvious and will in part appear hereinafter. The invention accordingly comprises the apparatus possessing the construction, combination of elements, and arrangement of parts which are exemplified in the following detailed disclosure, and the scope of the application of which will be indicated in the claims.

For a fuller understanding of the nature and objects of the present invention, reference should be had to the following detailed description taken in connection with the accompanying drawings wherein:

FIG. 1 is a block diagram showing the elements of a novel circuit for providing all three types of output signals;

FIG. 2 is a timing diagram showing exemplary, idealized wave-forms occurring at various points in the diagram of FIG. 1; and

FIG. 3 is a detailed schematic circuit diagram of a. portion of the embodiment of FIG. 1.

Referring now to FIG. 1, there is shown an embodi ment of the present invention comprising input terminal 20 at which an electrical signal in. the form of a pulse train indicative of a heart beat (such as is obtained by electrocardiographic electrode) is intended to be applied. Preferably, input terminal 20 is connected to amplifier 22 for increasing the amplitude of the signals. Amplifier '22 is conveniently a high input impedance amplifier which is also frequency selective so as to filter out interfering high frequency noise.

The output of amplifier 22 is connected to pulse generator 24 which provides, responsively to the input pulses above a given level, a series of uniform, i.e. cleaned-up, pulses each of fixed amplitude and duration, and abrupt rise and fall times. Typically, the pulse generator can be a Schmitt trigger circuit or an overdriven amplifier normally biased otf (Class C). The output of generator 24 is connected to the trigger input of monostable multi- 3 vibrator or one-shot 26, i.e. a two-state device having a stable and a quasi-stable state. The one-shot is intended to provide a train of square-wave pulses each of equal energy content and spaced in time corresponding to the input heart rate pulses at terminal 20. The output of oneshot 26 in turn is connected to averaging circuit 28. The latter typically comprises the usual leaky RC circuit (series resistor with capacitor shunted to ground) having a rather long time constant with respect to the normal heart rate at rest. The output of averaging circuit 28 is connected to an indicating device such as meter 30.

It will be apparent that the device as thus described is simply a typical averaging cardiotachometer. In operation, a pulse train is introduced at terminal 20 such as is shown in FIG. 2 at A. The pulses are idealized forms of the R wave of the usual cardiographic wave form, an ectopic beat being shown at 32 interposed between two regular heart beat pulses. These pulses are passed through amplifier 22, emerging with greater amplitude such as is shown in B of FIG. 2, the pulse time spacing remaining unchanged. Because these pulses are not appropriate for triggering a nonostable multivibrator (e.g. the amplitude frequently varies widely from pulse to pulse) it is preferred to further process or shape the pulse train. Hence, the amplifier output is shaped, as in generator 24 emerging as rectangular pulses of substantially constant amplitude and short fixed duration as shown in FIG. 2C. The leading edge of each pulse of FIG. 2C triggers one-shot 26 to induce a rapid transition in the latter from its stable to its quasi-stable state where the device remains for a predetermined time long in comparison with the transition time from state to state. The one-shot finally drops back to its stable state without further triggering. This serves to produce an output which is a substantially rectangular wave of constant amplitude and a duration preferably less than the minimum interval expected between heart beats. For example, if the instrument is designed to measure heart beat rates as high as 250' p.p.m., then the one-shot should produce a square wave of less than 140 milliseconds, preferably about 120 milliseconds. The energy of these square waves is averaged in time by circuit 28 to provide the wave-form shown in FIG. 2E to meter 30. As is seen, FIG. 2E is a slowly (exaggerated in amplitude for purposes of exposition) varying signal level due to the slow time constant of the RC tank of circuit 28 which typically provides a signal decay of 1 to 2% during a pulse interval of, for example, 720 milliseconds (corresponding to about a heart beat rate of 85) Referring again to FIG. 1, the output of one-shot 26 is also connected to the input of differentiator circuit 34, typically a passive RC circuit or an operational amplifier with a capacitive input impedance and a resistive feedback, in order to duplicate the original pulse train input. The output of circuit 34 is connected both to the input of second pulse generator 36 and the input of delay line 38. The former can be similar to pulse generator 24 whilst the delay line can be any of a number of known devices such as the well known magnetostrictive delay line. The output side of generator 36 is connected to first relay driver amplifier 40, the output of delay line 38 being connected to second relay driver amplifier 42.

First relay controlled switch means 44 is coupled to driver amplifier 42 so as to be operable by the latter for selectively connecting and disconnecting an input connected to DC power source 46 with an output connected to capacitor discharge circuit 48. The output of the latter is connected to an input of a second relay controlled switch means 50. That input of the latter is selectively connected or disconnected to an output coupled to capacitive storage means 52 according as the operation of switch means 50 is controlled by its connection to the output of driver amplifier 40. The output of capacitive storage device 52 is connected to the input of high impedance amplifier 54.

Referring now to FIG. 3 there will be seen an exemplary circuit schematic of a number of elements of FIG. 1 in somewhat more detail. Switch means 44 includes relay coil 56 one side of which is connected to the output from amplifier 42, and the other side of which is grounded. Coil 56 is magnetically couplable to switch armature 58 which is thereby moveable to open or close a circuit between input terminal 60* and output terminal 62. Power source 46 shown as a battery is connected between input terminal 60 of switch means 44 and ground. Capacitive discharge circuit 48 comprises capacitor 64 connected between ground and input terminal 66, the latter being, of course, connected to output terminal 62 or" switch means 44. Additionally, the capacitive discharge circuit includes resistor 68 connected in series between input terminal 66 and output terminal 70*, and also preferably includes another resistor 72 connected between ground and output terminal 70.

Second switch means 50* includes input terminal 74 and output terminal 76 selectively connectable or disconnectable by moveable switch armature 78, the latter being magnetically coupled so as to be moved by relay coil Coil 80 is connected between the output of amplifier 40 and ground. Capacitor storage device 52 can simply be a capacitor connected between output terminal 76 and ground, output terminal 76 also being connected to the input of high impedance amplifier 54.

The device as thus described starting with circuit 34 will be recognized by those skilled in the art to substantially meet the requirements for a beat-by-beat cardiotachometer and operates in the following manner.

Differentiator 34 essentially reconstitutes the timing of the original pulse train and produces a bipolar output by differentiating the transitions of the output of the one-shot as shown in FIG. 2F. These pulses are applied both to pulse generator 36 and delay line 38. Pulse generator 36, preferable of the type that responds to a unipolar pulse, e.g., a negative-going transition, generates a rectangular pulse train as shown in FIG. 2G, quite similar to the train of FIG. 2C but of opposite polarity for the sake of clarity in exposition. Meanwhile, the pulses from differentiator 34 are delayed by delay line 38 to provide the waveform shown in FIG. 21, so that the pulses corresponding to the original pulse train of FIG. 2A occur just later than the occurrence of the decay transition of the pulses from generator 36. In other words, each pulse of FIG. 26 is complete just before a corresponding pulse emerges from delay line 38. The pulses as shown in FIG. 2G have been exaggerated in duration for the sake of clarity and, of course, are preferably much shorter.

Thus, the pulses from the delay line are amplified in amplifier 42 and operate switching means 44 by actuating relay coil 56 to close armature 58 for a series of brief intervals shown as solid lines in the otherwise broken line of FIG. 2]. At each such interval battery 46 provides a potential which is applied to capacitor 64 to change the latter. When armature 58 returns to its normally open position, the change on capacitor 64 decays with a time constant set by the RC values of circuit 48. Hence, a series of ramps are presented to switching means 50, each starting contemporaneously with an original heart beat pulse as shown in FIG. 2K. However, switching means 50 is operated by the rectangular pulses from amplifier 40 applied to relay coil 80 to close armature 78 from its normally open position for a series of brief intervals shown as solid dashes in FIG. 2]. Each closure of armature 78 therefore samples the potential at terminal 74 for a predetermined interval expiring just prior to recharging of capacitor 64. This sample level is stored in capacitor 52 which is comparatively non-leaky due to the high impedances provided by switch 50 when open and by amplifier 54. Hence, the input to the latter is a step-function, as shown in FIG. 2L wherein the signal level is quite stable and varies abruptly only when the repetition rate changes, as shown by the presence of ectopic beat 32.

The output of amplifier 54 is connectable to meter 82 which therefore can indicate the instantaneous heart beat rate. The output of amplifier 54 is also applied to one input of dilferential amplifier 84 whilst the output of averaging circuit 28 is applied to the other input of amplifier 84. The latter, well known in the art, is of the type that produces an output signal the amplitude of which is the algebraic difference between the absolute values of the two signals at its respective inputs.

It will be seen that the amplitude of both the signals at the inputs to amplifier 84 will vary substantially with changes in repetition rate of the heart beats, one instantaneously, the other averaged over a much longer time period. However, the amplitude of the difference signal at the output of amplifier 84, as shown (exaggerated in the amplitude of the ripple) in FIG. 2M and as displayed for example on meter 86 connected to amplifier- 84 will not vary substantially in amplitude if the heart beat repetition rate says constant or if the heart beat repetition rate changes at a substantially constant rate, i.e. the difference signal stays constant for both dP/dt=0 and dP/dt=K where dP/dt is the change in rate of rate of heart beat. Thus, a change in signal amplitude at meter 86 is indicative of a' P/a't or the anomalous beats known as ectopic beats.

Because a small ripple will otherwise occur in the output of amplifier 84 as noted in the combined wave form of FIG. 2M, it is preferred that amplifier 84 be of the threshold type, i.e., produces an output signal only when the difierence between the amplitude of the two input signals exceeds a predetermined amount greater than the ripple but less than the change produced by the occurrence of an ectopic beat.

While the device as thus described is quite capable of indicating the presence of an ectopic beat, in the event that a plurality of ectopic beats should occur within thetime interval between one or two regular heat beats, the large amplitude portion of the output signal of amplifier 84 simply becomes extended in duration. Therefore, it becomes quite difficult to distinguish between only a single ectopic beat or a number of ectopic beats occurring within a very short period of time. Because there is clinical significance to the frequency or number of ectopic beats that occur, the present invention also includes means for detecting a plurality of ectopic beats which occur within a short time interval, e.g. the interval between two or three regular heart beats.

To this end, the present invention preferably includes means for discriminating ectopic beats from one another. This is preferably accomplished by including AND gate 90, an enabling input terminal of which is connected to the output of amplifier 84. Another input terminal of gate 90 is connected to the output of relay driver 40.

Connected to the output of gate 90 is divide-by-two circuit 92, typically a flip-flop, which provides at an output thereof one pulse for every two pulses applied at its input. The output of circuit 92 finally is connected to pulse counter 94, which preferably counts pulses in a decimal mode.

Thus, when an ectopic beat occurs, as previously noted, the amplitude of the output of thresholding differential amplifier 84 increases sharply. This serves to enable gate 90. Now when pulses from amplifier 40 operate relay coil 80, the normal inductive delay of the latter together with the inertia of armature 78 cause each sampling interval of potential at terminal 74 to begin and end respectively delayed with respect to the rise and decay time of each corresponding such pulse. Hence, a pulse causing the output of amplifier 84 to rise will have decayed before that output rise enables gate 90. However, subsequent pulses from amplifier 40 will be transferred by gate 90 until the latter becomes disabled. Of course, other techniques can be used to provide the small relay required to insure that the pulse causing the output of amplifier 84 to rise will decay before gate 90 is enabled, and thus that that pulse is not grounded. As will be seen by examining the wave-forms of FIG. 2, after the occurrence of a pulse 'from generator 36 (shown at FIG. 26) corresponding to ectopic beat, the signal amplitude at amplifier 84 rises as shown in FIG. 2M, The next two pulses from generator 36 occur while the output from amplifier 84 is at a high level and therefore will be transmitted to circuit 92 to provide but a single output signal which is then counted or registered by counter 94.

Now assume that two ectopic beats occur spaced by a regular pulse beat. The output of amplifier 84 would then merely indicate a somewhat longer duration signal but give no other evidence of the multiplicity of ectopic beats. However, during the time that amplifier 84 enabled gate 90, four pulses would be passed by gate These would cause two pulses to appear at the output of counter 94, thus indicating the occurrence of the two ectopic beats.

Since certain changes may be made in the above apparatus without departing from the scope of the invention herein involved it is intended that all matter contained in the above description or shown in the accompanying drawing shall be interpreted in an illustrative and not in a limiting sense.

What is claimed is:

1. Apparatus for detecting ectopic beats in a train of heart beat pulses, said apparatus, comprising:

first means responsive to said train for providing a first signal, the amplitude of which is the average of the repetition rate of said train weighted to give the most significance to the most recent measurement of said rate and the least significance to the most remote measurement of said rate;

second means responsive to said train for providing a second signal the amplitude of which varies according to measurement of substantially only the interval between the last two pulses in said train;

third means for determining the difference in amplitude between said first and second signals so as to provide a third signal indicative of changes in the rate of change of said train caused by one or more ectopic beats, and;

fourth means connected to said second and third means for generating a pulse corresponding to each of said ectopic beats.

2. Apparatus as defined in claim 1 wherein said second means comprises:

means for producing a second pulse train delayed with respect to said train of heat beat pulses;

a leaky capacitive discharge circuit;

means for charging said discharge circuit periodically according to the repetition rate of said second pulse train; and

means for sampling the output of said discharge circuit periodically according to the repetition rate of said train of heart beat pulses so as to provide said second signal; and

said fourth means comprises gating means having an input terminal connected to said means for producing said second pulse train and an enabling input terminal connected to said third means so as to be enabled by said third signal for transmitting said second pulse train;

means for dividing by two the number of pulses from said gating means; and

means for counting the number of pulses from said dividing means.

3. Apparatus as defined in claim 2 wherein said first means comprises:

means for producing rectangular waves of substantially uniform energy content, each corresponding in time to one of said pulses;

means for averaging the energy content of said waves so as to provide said first signal.

4. Apparatus as defined in claim 2 wherein said means for producing said rectangular waves comprises.

an electrical pulse generator having its input connected to said train for producing a series of shaped pulses corresponding in time to the pulses of said train; and

a monostable multivibrator triggered by said shaped pulses for providing rectangular waves of duration less than the minimum interval between pulses in said train at the highest expected repetition rate of the latter.

5. Apparatus as defined in claim 4 wherein said means for charging comprises a DC power source:

first normally open switching means operable to close responsively to the pulses of said second pulse train for connecting said power source to said discharge circuit; and

said means for sampling comprises a capacitive storage device;

second normally open switching means operable to close responsively to the pulses of said train of heart beat pulses for connecting the output of said dis- 2 charge circuit to said storage device;

the pulses of said second train being delayed by an interval sufficient to allow said second switching means to be closed for an interval just preceding the advent of the next corresponding pulse of said train of heart beat pulses.

References Cited UNITED STATES PATENTS 2,439,495 4/1948 Sturm 128-205 2,492,617 12/1949 Boland et a1 128-2.06 2,848,992 8/1958 Pigeon 1282.O5 3,087,488 4/1963 Streimer 128--2.05 3,138,151 6/1964 Chapman et al. 128--2.0"5 3,202,149 8/1965 Ernrnons 1282.05 3,228,391 1/1966 Fitter et a1 128-205 3,267,934 8/1966 Thornton 1282.06 3,352,300 11/1967 Rose 1282.06

0 WILLIAM E. KAMM, Primary Examiner. 

1. APPARATUS FOR DETECTING ECTOPIC BEATS IN A TRAIN OF HEART BEAT PULSES, SAID APPARATUS, COMPRISING: FIRST MEANS RESPONSIVE TO SAID TRAIN FOR PROVIDING A FIRST SIGNAL, THE AMPLITUDE OF WHICH IS THE AVERAGE OF THE REPETITION RATE OF SAID TRAIN WEIGHTED TO GIVE THE MOST SIGNIFICANCE TO THE MOST RECENT MEASUREMENT OF SAID RATE AND THE LEAST SIGNIFICANCE TO THE MOST REMOTE MEASUREMENT OF SAID RATE; SECOND MEANS RESPONSIVE TO SAID TRAIN FOR PROVIDING A SECOND SIGNAL AMPLITUDE OF WHCIH VARIES ACCORDING TO MEASUREMENT OF SUBSTANTIALLY ONLY THE INTERVAL BETWEEN THE LAST TWO PULSES IN SAID TRAIN; THIRD MEANS FOR DETERMINING THE DIFFERENCE IN AMPLITUDE BETWEEN SAID FIRST AND SECOND SIGNALS SO AS TO PROVIDE A THIRD SIGNAL INDICATIVE TO CHANGES IN THE RATE OF CHANGE OF SAID TRAIN CAUSED BY ONE OR MORE ECTOPIC BEATS, AND; FOURTH MEANS CONNECTED TO SAID SECOND AND THIRD MEANS FOR GENERATING A PULSE CORRESPONDING TO EACH OF SAID ECTOPIC BEATS. 